AANP Family Nurse Practitioner (FNP) Certification ExamPlanHard
A 48-year-old female presents with symptoms consistent with acute sinusitis. She has been experiencing facial pain, nasal congestion, and purulent nasal discharge for 8 days, with no improvement. She has no fever, and her symptoms are not worsening. She has no known drug allergies. Which of the following is the most appropriate pharmacological management?
- ARecommend symptomatic treatment with nasal corticosteroids and analgesics.
- BOrder a CT scan of the sinuses to confirm diagnosis.
- CPrescribe azithromycin.
- DPrescribe amoxicillin-clavulanate.
Show answer & explanationAnswer & explanation
Correct answer: A. Recommend symptomatic treatment with nasal corticosteroids and analgesics.
Acute rhinosinusitis symptoms lasting less than 10 days without worsening are often viral. Bacterial sinusitis should be suspected if symptoms persist without improvement for at least 10 days or worsen after initial improvement (double sickening). Given her symptoms are not worsening and have not reached 10 days, symptomatic treatment is the most appropriate initial management.
Why the other options are wrong
- B. A CT scan is not indicated for routine diagnosis of acute rhinosinusitis and is typically reserved for complicated cases or when considering surgical intervention.
- C. Azithromycin is not a first-line antibiotic for acute bacterial sinusitis due to increasing resistance and is not indicated for presumed viral sinusitis.
- D. Amoxicillin-clavulanate is a first-line antibiotic for bacterial sinusitis, but antibiotics are not indicated at this point as bacterial infection is less likely given the duration and lack of worsening symptoms.
Acute Rhinosinusitis Management
Most cases of acute rhinosinusitis are viral and managed symptomatically; antibiotics are reserved for persistent or worsening symptoms (bacterial suspicion).
- Viral sinusitis typically resolves within 7-10 days.
- Bacterial sinusitis is suspected if symptoms >10 days without improvement OR 'double sickening'.
- First-line antibiotics for bacterial sinusitis include amoxicillin-clavulanate.
Memory trick: Sinusitis: Time tells if it's Bacterial or Just a sniffle.